The threatened self: general practitioners' self-perception in relation to prescribing medicine.

Insufficient understanding of the variation in GP's medicine prescribing behaviour and ineffective interventions call for an investigation of the GPs' own perspective. This article describes the GP's self-perception as it emerged in 20 semi-structured interviews that explored the GP's perspective on their own prescribing. Data collection and analysis was largely inspired by grounded theory. The GPs described a constantly active process in which they prescribed, experienced an emotional reaction to their prescribing, evaluated themselves, redefined themselves for the better or worse, defined the new prescribing situation, prescribed and so forth. The GPs felt disappointed with themselves when their prescribing conflicted with their human or scientific ideals, and when they did not live up to their image of themselves, as GPs and as persons. They experienced discomfort when they were exposed to pressure as well as when they gave in to it. These negative emotions demanded a redefinition of the GPs' selves. The GPs applied both preventive and coping strategies to protect themselves from redefining themselves negatively. They strived to live up to their ideals, lowered their ideals, convinced themselves of the appropriateness of their prescribing and sought inspiration and self-development. This study demonstrates that self-perception is fundamental to how GPs prescribe medicines. Future interventions in quality development that aim to improve GPs' prescribing practices should therefore include considerations of the GPs' self-perception and facilitate autonomous self-development. Copyright 2003 Elsevier Ltd.